A Case of Fatal Bleeding from Acute Varicose Leg Ulcer: Clinico-pathological Characteristics

Haemorrhage from varicose veins and varicose ulceration: A systematic review

“…Little less than 70 cases of venous bleeding has been reported in the scientific literature in the past 50 years . It has been estimated that deaths for bleeding due to peripheral venous problems account up to 0.01% of autopsy cases .…”

“…Victims are in general elderly people, usually in their sixth to ninth decades of life, especially if they live isolated, in fact the victims are often found in their homes where they had been alone at the time of death. Although venous problems of the legs are more common in females, there is no correlation of the bleeding event with gender or laterality of the lesions . Concomitant medical conditions, such as arthritis or weakness from cerebrovascular disease may also predispose to this kind of problem, as these conditions may affect mobility and reactivity of patients .…”

“…Although venous problems of the legs are more common in females, there is no correlation of the bleeding event with gender or laterality of the lesions . Concomitant medical conditions, such as arthritis or weakness from cerebrovascular disease may also predispose to this kind of problem, as these conditions may affect mobility and reactivity of patients . Anticoagulant drugs and skin fragility may also contribute to bleeding and concomitant cardiovascular disease, such as ischemic heart disease, may contribute to the fatal ending of the bleeding episode that happens for subsequent hypovolemic shock.…”

“…From a pathological point of view, venous bleeding may arise from either acute perforation of an enlarged vein segment through an overlying weakened skin layer or from an exacerbation of a VU followed by erosion of an underlying enlarged vein. In this context two types of ulceration related to venous hemorrhage have been described: the acute perforative type (APT) and the chronic ulcerative type (CUT) . The APT is a small (<5 mm) , shallow lesion with slight adjacent cutaneous pigmentation or eczema, according to C4a clinical stage.…”

“…The localization of a VV above a bone prominence (e.g. the medial malleolar site) may represent a mechanical factor for vein lesion . The sclerotic alterations of the vein wall of patients with CVI may also enhance the susceptibility of these vessels .…”